Diagnostic Performance Of Two-dimensional Shear Wave Elastography For Evaluating Tibial Nerve Stiffness In Patients With Diabetic Peripheral Neuropathy

Objective:To evaluate the stiffness of the tibial nerve with two-dimensional shear wave elastography(2D-SWE)and to determine whether 2D-SWE can be used to diagnose diabetic peripheral neuropathy(DPN).Method:The study included 70 consecutive diabetic patients with DPN or without DPN and 20 healthy volunteers.The tibial nerve stiffness measured with 2D-SWE was studied.The differences in stiffness values among patients with DPN,patients with clinically defined DPN,patients without DPN,and healthy volunteers based on clinical features and electrodiagnostic tests were evaluated with the Mann–Whitney U test and the Kruskal–Wallis test.A receiver operator characteristic curve analysis was conducted to assess the performance of nerve elasticity indicesResult:The tibial nerve stiffness based on,maximum(Emax)minimum(Emin),and mean(Emean)shear elasticity indices was significantly higher in patients with DPN and clinically defined DPN than that in patients without DPN and control subjects(p < 0.05).The area under the curve(AUC)for the SWE measurements of Emax,Emin,and Emean was 0.821,0.867,and 0.846,respectively.An Emin cutoff value of 45.7 kPa had a sensitivity,specificity,positive likelihood ratio,and negative likelihood ratio of 74.0%,87.6%,6.0,and 0.3,respectively according to Youden's Index.Conclusion:Tibial nerve stiffness of diabetic patients with DPN is significantly higher than patients without DPN and volunteers.2D-SWE can be used as a diagnostic method to evaluate DPN.Minor degree of peripheral nerve lesions appear to might exist in patients with clinically defined DPN,not detectable by electrophysiology.2D-SWE has a potential use for cases with clinically defined DPN and has a better correlation with clinical findings than electrophysiology.